Complex PCI among older patients linked to increased risk of death

Overall, 43.9% of patients underwent complex PCI. Complex PCI was defined as “any PCI including a procedure or lesion that may carry inherently elevated risk of complications or PCI failure.” The authors emphasized that complex PCI, a term defined by details of the procedure, is not the same thing as high-risk PCI, a term defined by the patient. The group also noted that patients undergoing to the two different treatment options did not differ significantly when it came to demographics or comorbidities.

The study’s primary endpoint—freedom from mortality, nonfatal myocardial infarction, nonfatal stroke or major bleeding events 12 months after PCI—was seen in 84% of patients. This translated to 86.8% among noncomplex PCI patients and 80.4% among complex PCI patients, a difference that was not significant after adjustments were made based on patient demographics and clinical details.

All-cause death after 12 months was 7.8% overall, and it was much more common among PCI patients (10.2%) than noncomplex PCI patients (5.9%). Even after making certain adjustments, the difference between the two treatment options remained in place. There was no significant difference when it came to cardiovascular deaths after 12 months.

“Given the dramatic difference in death risk for older adults receiving complex PCI, we suggest that such interventions in this exceptionally vulnerable population should be approached with additional caution and that further investigations are needed to define causality,” the authors wrote.

In addition, Nanna and colleagues found that the number of patients requiring target lesion revascularization (TLR) was low overall (2.9%). After making certain adjustments, the group did find that complex PCI was linked to a lower risk of TLR than noncomplex PCI.

“Ultimately, the absolute difference in TLR between complex versus noncomplex PCI was small (1%), and complex PCI was at least as effective as noncomplex interventions at maintaining target vessel patency,” the authors wrote. “Importantly, TLR has been identified as an independent predictor of worse outcomes, including death. Thus, the lower rates of TLR observed in the complex PCI groups certainly provide reassurance that older adults undergoing more technically complex procedures can experience excellent midterm revascularization outcomes.”

Bleeding events, meanwhile, impacted both groups of patients at a similar rate.

“Further investigation into the outcomes following complex PCI in older adults is needed,” the study’s authors concluded.

Click here to read the full study.